CLEVELAND -- Only about a third of children who are overweight or obese are diagnosed as such by pediatricians, researchers here said.

Action Points

Explain to interested patients that children who are overweight or obese are not often diagnosed as such.

Note that the researchers suggest that early diagnosis could lead to successful intervention, so primary care physicians should "take a stronger role in the identification and treatment of obesity and overweight."

CLEVELAND, Dec. 30 -- Only about a third of children who are overweight or obese are diagnosed as such by pediatricians, researchers here said.

Diagnosis was more likely, however, among obese and severely obese children, David C. Kaelber, M.D., Ph.D., of Case Western Reserve University School of Medicine, and colleagues reported in the January issue of Pediatrics.

"This is a bit of a wake-up call to pediatricians that . . . overweight children are not being properly diagnosed," Dr. Kaelber said.

Pediatric obesity has received considerable attention from the news media in recent years, the researchers said. But it's not clear whether this publicity has affected clinicians' diagnoses.

Previous studies have suggested that pediatric overweight and obesity are underdiagnosed, and that guidelines for treatment and evaluation are often not followed, they said.

To get an up-to-date picture, the researchers analyzed electronic medical records (EMR) data for 60,711 patients ages two to 18 who had had at least one well-child visit between June 1999 and October 2007 in the MetroHealth System, a large academic medical system in northeast Ohio.

On the basis of body mass index (BMI) measurements, 18.6% of patients were overweight and 23.2% were obese. Of the obese patients, 33.1% were severely obese.

Only 34.1% of all overweight and obese patients actually received a relevant ICD-9 code diagnosis, the researchers said.

Diagnosis was most likely the more obvious the problem: 75.6% of severely obese children were diagnosed as such, compared with 53.8% of obese kids, and just 9.5% of those who were overweight.

"Our study demonstrates a continued low percentage of diagnosis of pediatric weight problems, lowest among overweight children in whom intervention may be most beneficial," the researchers said.

Although there was a statistically significant trend toward increasing diagnosis over the study period (P<0.001), the percentage of diagnosed patients seemed to peak in 2005, the researchers said.

The percentage of all patients diagnosed with obesity or overweight increased from 13% in 1999 to 21.6% in 2005 but was down to 18.5% in 2007.

"The percentage of patients who were given a diagnosis is no longer increasing at an appreciable rate," the researchers said, implying that "the impact of publicity regarding weight problems may be reaching its peak."

They said primary care physicians should be encouraged to "take a stronger role in the identification and treatment of obesity and overweight," and suggested that electronic medical records may hold promise for doing so.

"As the role of EMR grows," Dr. Kaelber said, "new methods such as automatic electronic alerts being sent to pediatricians and parents about a child's weight status and automatic referrals to special pediatric weight-management programs . . . can help improve (pediatric) health."

The authors reported no disclosures.

Reviewed by Robert Jasmer, MD Associate Clinical Professor of Medicine, University of California, San Francisco

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